Pre-diagnostic delay among patients with curative esophageal and gastric cancer during the COVID-19 pandemic.

Authors

null

Xin Wang

Princess Margaret Cancer Centre, Toronto, ON, Canada;

Xin Wang , Osvaldo Espin-Garcia , Yvonne Bach , Hiroko Aoyama , Lucy Xiaolu Ma , Carly C. Barron , Thais Baccili Cury Megid , Eric Xueyu Chen , Jonathan Yeung , Carol Jane Swallow , Savtaj Singh Brar , Rebecca KS Wong , Aruz Mesci , John Kim , Patrick Veit-Haibach , Sangeetha Kalimuthu , Raymond Woo-Jun Jang , Elena Elimova

Organizations

Princess Margaret Cancer Centre, Toronto, ON, Canada; , Ontario Cancer Institute, Princess Margaret Cancer Centre, Toronto, ON, Canada; , Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; , Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada; , University of Toronto, Toronto, ON, Canada; , Sírio Libanês Hospital, São Paulo, AB, Brazil; , Division of Thoracic Oncology, Toronto General Hospital, University Health Network, Toronto, ON, Canada; , Department of Surgical Oncology, Princess Margaret Cancer Centre and Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada; , Princess Margaret - University Health Network, Toronto, ON, Canada; , Division of Radiation Oncology, Princess Margaret Hospital, University Health Network, Toronto, ON, Canada; , Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada; , Joint Division of Medical Imaging (JDMI), University Health Network, Toronto, ON, Canada; , Laboratory Medicine Program, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada;

Research Funding

No funding received
None.

Background: The majority of esophageal and gastric cancers are diagnosed at an advanced stage with poor overall survival (OS), leading some to propose screening, even in countries with a low incidence. Whether diagnostic delay from symptom onset has any impact on OS is unclear. We investigated this question in the peri-COVID19 pandemic era. Methods: We retrospectively analyzed a cohort of 308 patients with esophageal, gastroesophageal junction, or gastric carcinoma treated with curative intent at the Princess Margaret Cancer Centre from January 2017 to December 2021. Clinical details pertaining to the initial presentation were determined through a retrospective chart review. OS was estimated using the Kaplan-Meier method. Cox proportional hazards regression models were used to assess the association between pre-diagnostic interval with OS adjusting for baseline patient characteristics. Results: The median interval from symptom onset to diagnosis was 98 days (IQR 47-169 days). Using a cox proportional hazard model, prolonged pre-diagnostic interval was not associated with worse OS (HR 1.00, P=0.62). Comparing patients diagnosed before and during the COVID19 pandemic, there was a notable increase in diagnostic delay with median pre-diagnostic interval increasing from 92 to 126 days (P=0.007). Median age at time of diagnosis was 69.6 during the pandemic vs 64.7 before the pandemic. Linear regression showed squamous cell histology was significantly associated with increasing time to initial diagnosis (P=0.04). Looking at other delay metrics, there were no changes in time interval from diagnosis to treatment during versus before the pandemic (median = 1.7 weeks for both), and there was no change in time from diagnosis to resection in those patients who underwent surgery. Conclusions: The COVID19 pandemic caused significant diagnostic delay for patients presenting with curative esophageal and gastric cancer. We found no evidence of pandemic-related health system delays in treatment, once a diagnosis was made. The lack of correlation of pre-diagnostic interval with OS may reflect underlying tumour biology as the driving force that determines prognosis.

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Abstract Details

Meeting

2023 ASCO Gastrointestinal Cancers Symposium

Session Type

Poster Session

Session Title

Poster Session A: Cancers of the Esophagus and Stomach and Other GI Cancers

Track

Esophageal and Gastric Cancer,Other GI Cancer

Sub Track

Impact of COVID-19

Citation

J Clin Oncol 41, 2023 (suppl 4; abstr 302)

DOI

10.1200/JCO.2023.41.4_suppl.302

Abstract #

302

Poster Bd #

C1

Abstract Disclosures

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